| NPI | 1821607680 |
|---|---|
| Former Legal Business Name | ANGKOR WAT ALTERNATIVE CARE |
| Entity Type | Organization |
| Authorized Contact | BRENDON GERALD RAVENS Administrator 970-201-6678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2020-07-28 |